Affordable Care Act PCORI Fee Due July 31

As a reminder, the ACA developed the Patient-Centered Outcomes Research Institute (PCORI), whose mandate is to improve the quality and relevance of evidence available to help patients, clinicians, caregivers, employers, insurers, and policy makers make informed health decisions. In order to fund the comparative effectiveness research, the ACA imposes an annual fee, which is paid to the IRS. This year the due date is July 31, 2019.

Don't miss the PCORI fee deadline on July 31, 2019

If a plan is fully insured, then the health insurer is responsible for paying the fee. For self-insured plans, the plan sponsor (generally the employer) is responsible for paying the PCORI fee.

For self-insured health plans, the fee is calculated using the average number of total lives covered by the plan (both employees and dependents). The requirement for calculating the total fee is to use one of the following three calculation methods:

  • Actual count method
  • Snapshot method
  • Form 5500 method

Plan Sponsors should review all three methods to determine the lowest amount to be paid. The amount to pay depends on the plan year end as outlined below:

  • Plan years ended 1/1/2018 – 9/30/2018:
    $2.39 per covered life (including spouses and children)
  • Plan years ended 10/1/2018 – 12/31/2018: $2.45 per covered life (including spouses and children)

The PCORI fee is set to expire for plan years that end before October 1, 2019, therefore this will be the final PCORI filing for calendar year-end plans.

The PCORI fee is filed using IRS Form 720 (https://www.irs.gov/pub/irs-pdf/i720.pdf). The payment voucher (720-V) should indicate that the tax period for the fee is the “second quarter” to avoid the IRS’s software system marking this as a tardy filing notice.

For more information, contact Dave Barchet at 216.875.1914, Dave.Barchet@findley.com or John Lucas at 615.665.5329, John.Lucas@findley.com or the Findley consultant with whom you normally work with.

Published June 7, 2019

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Affordable Care Act Preventative Services Updates for 2019

Section 2713 of the Affordable Care Act (ACA) requires group health plans and health insurers to provide coverage for a variety of preventative care services without any cost sharing requirements (deductibles,coinsurance, and copayments). This list of preventative care receives yearly additions and modifications, which must be integrated into health plans within the following two years. These recommendations are made by organizations such as the U.S. Preventative Services Task Force, Bright Futures, and the Advisory Committee on Immunization Practices. Here are some of the recommendations that must be integrated into health plans for the 2019 calendar year:

  • Preeclampsia screening through blood pressure tests
  • Obesity screenings for children and adolescents 6 years and older
  • Vision screening in children ages 3 to 5 to detect amblyopia or its risk factors
  • Influenza vaccine for adolescents
  • Hepatitis B vaccine for adolescents
  • Human papillomavirus (HPV) vaccine for adolescents

This year’s updates appear to focus on improving women’s health during pregnancy and adolescent health in general. While the list above is not exhaustive, here area few resources if you would like to find out more:

  • A list of all recommendations from the U.S. Preventative Services Task Force may be found here.
  • The approved Periodicity Schedule from Bright Futures may be found here
  • ACIP Vaccine Recommendations and Guidelines may be found here
  • Current preventative services for adults, women, and adolescents may be found here

Questions? Contact the Findley consultant with whom you normally work or Kadin Llewellyn at 419.327.4103, Kadin.Llewellyn@findley.com.

Posted December 18, 2018

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